Maker Pro
Maker Pro

I'm Grandfathered in, for now.

S

sms

Jan 1, 1970
0
Except they won't. Way too many voters like my daughter (minimally
employed) that benefit to get rid of them so easily. Though i admit that
the sticker shock may disenchant a lot of them.

When they poll about the ACA there's always a big majority in favor of
most of the provisions, including allowing children to remain on their
parent's policy (which isn't free--the insurer can charge for this). The
ban on denying insurance based on pre-existing conditions is also very
popular. There's a slight majority against the mandate, but only very
slight.

Overall, the Tea Partiers keep insisting that a majority is opposed to
the ACA, but they leave out the fact that 16% of those that say they
oppose the ACA opposie it because they think it doesn't go far
enough--they would prefer single-payer (like most industrialized
countries have). Add that 16% to the 43% that say they support ACA and
you're at 59%, which would be considered a landslide in presidential
politics.

It's not an exaggeration that the only real objection to Obamacare by
the right wing is the "Obama" part of it.

What's really going to be on voter's minds in 2014, assuming they
haven't forgotten about it by then, is the way the Republican House
behaved and forced the government shutdown and how they allowed the U.S.
to come to the brink of default. Hopefully that will translate into the
Democrats winning the control of the House of Representatives as well as
retaining the Senate. The only hope to move the country forward is to
get rid of the obstructionist Tea Bagger Republicans. Normal Republicans
would be okay if they were not being forced to do stupid things by the
Tea Baggers.
 
J

Joerg

Jan 1, 1970
0
Bill said:
Obviously not, but they don't unambiguously support the conclusion
you want them to support. There are other ways of looking at them.


No. Early screening and polyp removal are an explanation of the
difference. Without numbers for incidence of polyp removal it's just
an explanation, ...


Those numbers I had given. See links below.

... not the only possible explanation - there are others,
and differences in diet and age are equally plausible.

A better diet? In the US? You've got to be kidding.

Nothing I've said contradicts clinical evidence. ...


Sure it does. You said "unsubstantiated" and that is simply wrong.
Before I'd make such lofty statements I'd have looked up the topic and
would be ready to back up such claims.

... It does question
your explanation of the clinical evidence, which does leap on an
obvious explanation and ignores all the alternative explanations with
all the confidence of the converted. Try to think like a scientist
for a bit, and see if you can find - and perhaps test - a few
alternative hypotheses.

In medical, we think in clinical studies and base our strategies on
those. That has worked well for at least a century. You are welcome to
ignore that, it won't make a difference.
from colon cancer was about 90% lower if people underwent both the
initial and follow-up procedures than if they underwent neither".
denial about it but that won't changes these medical facts.

All these medical facts demonstrate that polyp-snipping works, which
I'm happy to accept.

They don't demonstrate that polyp-snipping is carried out on a large
enough scale to explain why US colon cancer rates are around
34.1/25.0 per 100,000 for males and females while the Canadian rates
are 45.4 and 31.8.

It is standard practice here and the clinical studies clearly bear out
the benefits.

If polyp-snipping was as good and as wide-spread as you seem to be
claiming, you'd expect a substantially larger difference.

There is a simple reason: Many Americans dread the thought of a
colonoscopy and push that out. "I can always do that next year ... or
the year after that". Some never get one. Our health care plan folks are
very pushy on this. others are not so pushy. If you are even a few weeks
overdue on some screening procedure you get a call. But in a free
country you cannot force people to report for their colonoscopy on
Thursday morning at 8:00am sharp.
 
S

sms

Jan 1, 1970
0
Greegor wrote:
G > They've known from the beginning that
G > getting young healthy people to sign
G > up is necessary for it to work.
G >
G > Now there are reports that in fact
G > those people are busy repaying student
G > loans, hoping to buy homes and
G > would pay the 1% tax/fine rather
G > than sign up.

Joerg wrote:
J > Not just students and young people. Lots
J > of people in their 30's and 40's with
J > incomes above the government subsidy
J > threshold live paycheck to paycheck,
J > along with some hefty five-digit credit
J > card debt. They have about the financial
J > "discipline" of our government which is
J > what got them into this situation. Even
J > if they were willing to plunk down $1k
J > or more per month for a family plan,
J > they can't.
J >
J > Those who do buy an Obamacare plan and
J > are above the thresholds will soon
J > discover that it's really only
J > catastrophic coverage and that they must
J > pay the first few thousand Dollars out
J > of pocket. Dollars they ain't got.
J >
J > Imagine a guy picking up his son from
J > the hospital after he turfed it badly
J > on his skateboard. He was dumped out of
J > his previous family plan despite Obama
J > having promised they could keep it, so
J > now he has an Obamacare bronze plan.
J > "Sir, that'll be $786.43 please"
J > ... "WHAT?!".
J > This will happen before the next
J > election and registered Democrats are
J > not exempt from it.

Obamacare seems to be riddled with various
likely failure modes but so far it seems
to me that the strongest contender is
sticker shock for liberals themselves.

I have serious doubts that this fiasco
will cause liberals to embrace a single
payer system or outright socialist medicine.

How could the failure of this steaming pile
make anybody want an even larger pile of the same?
How could the broken promises make
people want more broken promises?

Ultimately the U.S. is going to have to follow the lead of all other
western industrialized democracies and move to single payer. The ACA is
the best that could be done for now, but as the demographics change in
the U.S. and Republicans are voted out of office there will be an
opportunity to introduce a better system. It's not going to be an option
because the present system is not sustainable. Eventually big business,
other than insurance companies of course, will force this change.

What's ironic is that independent senator Joe Lieberman once proposed
what made the most sense--expanding the age range of Medicare. The
system is in place, it's highly efficient (much more so than private
insurance), and it keeps costs very low. The problem occurred when the
insurance companies in Connecticut told Lieberman to stop pushing for this.

If we were serious about erasing the deficit we'd expand Medicare into a
single payer health care system for everyone. That would bring medical
costs down to those in other countries. As it is now, we spend the most
but don't achieve the results other countries achieve at far lower cost.

<http://www.commonwealthfund.org/~/m...t_sys_comparison_12_nations_intl_brief_v2.pdf>
 
H

hamilton

Jan 1, 1970
0
The Tea Baggers are concerned about the individual mandate penalty:

http://www.washingtonpost.com/blogs...l-mandates-penalty-costs-more-than-you-think/

As the Tea Baggers have been about NOT paying any taxes, they really
dislike the "IRS act of 2010" also known as ACA.

The ACA act gives new powers to the IRS to track and penalize those
without insurance.

Don't you think the IRS will not only penalize a taxpayer who does not
have insurance, but will also check if there are any outstanding taxes due.

Every time a taxpayer goes to see a doctor or into a hospital, the IRS
will be given your data to "check".

The Tea Baggers have been around long before the Koch Brothers gave it a
White Wash.

Even though the media seems to think it new:

http://thinkprogress.org/climate/20...created-by-big-tobacco-and-pollutocrat-kochs/

h
 
S

sms

Jan 1, 1970
0
When Obamacare implodes, what other choice than single payer is there?
Since the "You can keep your insurance if you like it" promise was a big
lie, it appears that much of the traditional American health care has
already successfully been destroyed. Cancellation notices have already
been sent out in droves, employer plans have been dumped by bucketloads.
Or in engineering terms, we are past the point of no return.

Of course the facts are radically different.

<http://eba.benefitnews.com/health-i...ployees-Into-Exchange-Expected-2736745-1.html>
 
S

Spehro Pefhany

Jan 1, 1970
0
Bill Bowden wrote:

[...]
It's amazing the new law requires so many undesired benefits. Women
for example get mandated benefits for all kinds of sexual problems.
Somebody has to pay for all that stuff. No wonder rates go up.

Even sex change operations are mandatory coverage now under this
Obamacare. No kidding.

It was only a matter of time before sex change operations became
mandatory. I guess we'll be calling you Joelle.

--sp
 
J

Joerg

Jan 1, 1970
0
sms said:

"Facts"? From a blog? The reality has long since started:

http://www.nbcnews.com/business/wal...-employees-private-health-exchange-4B11187909

"Shifting" is code for "dumping". Even unions joined the fray:

http://washingtonexaminer.com/kroge...umping-spouses-into-obamacare/article/2535352

Then there is the rapidly growing group of 29h-workers. I have met many
whose hours were already cut to 29h or less. That will escalate next year.
 
J

Joerg

Jan 1, 1970
0
sms said:
Ultimately the U.S. is going to have to follow the lead of all other
western industrialized democracies and move to single payer. ...


Nope. Germany does not have a siongle-payer system yet has one of the
better health systems. At slightly above half the cost of the US system.
But they don't have a screwed-up tort law which is a major chunk of our
problem, something Dems will never deal with for obvious reasons.

... The ACA is
the best that could be done for now, ...


It is not. It's one of the worst attempts of health reform I ever saw,
and being in the med biz and having lived in different parts of the
world I have seen a few.

... but as the demographics change in
the U.S. and Republicans are voted out of office ...


Dream on. Obamacare could become the big hammer causing "Shellacking 2.0".

[...]
 
J

Joerg

Jan 1, 1970
0
Bill said:
Bill Bowden wrote:



[...]


It's amazing the new law requires so many undesired benefits.
Women for example get mandated benefits for all kinds of sexual
problems. Somebody has to pay for all that stuff. No wonder rates
go up.


Even sex change operations are mandatory coverage now under this

Obamacare. No kidding.

Regards, Joerg

Yes, that's enlightning, but sex change operations seem to be only
covered in life and death situations where the patient might die if
he/she doesn't get the procedure. It probably excludes elderly people
past 60 years of age who don't care about sex. But they still pay the
medical bills and the doctors and hospitals make money.

Way it was explained in our plan under mandate changes was that it's a
"benefit" to everyone.
 
S

sms

Jan 1, 1970
0
On 11/5/2013 9:24 AM, Joerg wrote:

Nope. Germany does not have a siongle-payer system yet has one of the
better health systems. At slightly above half the cost of the US system.
But they don't have a screwed-up tort law which is a major chunk of our
problem, something Dems will never deal with for obvious reasons.

In reality tort law is a tiny part of the problem despite the efforts of
the right-wing tea-partiers to portray it as a big problem.

The non-partisan CBO stated that tort reform would save 0.5% in total
medical costs. The problem is that a few high profile cases lead naive
people to believe that there are far more malpractice suits than
actually exist and the right wing uses these high profile cases to
spread their misinformation because their handlers have a vested
interest in the issue.

"A report by the consumer advocacy group Public Citizen demonstrated
that the total value of malpractice payments (money paid to resolve
claims) on behalf of providers has been decreasing since 2001 and was
the lowest on record in 2011. While malpractice payments decreased,
healthcare spending nearly doubled over the same period, negating the
claim that malpractice litigation contributes to rising healthcare costs.

An examination of the impact of tort reform in Texas supports this
perspective. In 2003, Texas imposed a cap of $250,000 on noneconomic
damages for medical liability claims. Since then, total malpractice
claim payments have declined 65 percent, but health insurance rates and
per-patient Medicare spending has increased faster in Texas than the
national average." Of course the reason that Texas's costs increased
faster after tort reform could be coincidental and due to other factors,
you can't claim causation when it could just be correlation.

Nor is it clear that so-called "defensive medicine" actually adds to
overall health care costs.

Some health economists believe that the fear of malpractice lawsuits is
actually a good thing because it forces hospitals to be more efficient
and to set up systems for things like infection control and drug
verification. One thing you'll notice in U.S. hospitals is that new
hospitals have mostly single rooms because rooms with multiple patients
cause more problems than is worth the savings in cost.
 
S

sms

Jan 1, 1970
0
Nope. Germany does not have a siongle-payer system yet has one of the
better health systems.

Technically it's multi-payer, but the concept is pretty much the same.
It's just that there are mandatory private contributions. It's not like
the U.S. where almost all of the non-Medicare costs of health care are
private. The problem in the U.S., which Romneycare and the ACA addressed
was the subsidizing of those that could afford insurance but decided
that it was better to freeload, especially given the EMTALA which is
basically an unfunded mandate. But it's an unfunded mandate that was
made necessary in the first place by the screwed up health care system,
so blaming Reagan for signing it into law isn't fair either.
 
J

Joerg

Jan 1, 1970
0
sms said:
On 11/5/2013 9:24 AM, Joerg wrote:



In reality tort law is a tiny part of the problem despite the efforts of
the right-wing tea-partiers to portray it as a big problem.

No, it is not tiny. I leads to over-medication, over-examination, tons
of unnecessary expense. I've been on the beat in med tech for over 25
years now. The topper, when I asked a doc why they bought Acuson
ultrasound machines all the time: "Well, these are by far the most
expensive and I agree with you that we don't need them. But then nobody
in court can accuse us of not having done the best". One of many, many
examples. Leftists stick their heads in the sand about it but that does
not make it go away.

The non-partisan CBO stated that tort reform would save 0.5% in total
medical costs.


Complete nonsense. Sorry, but that's what it is.

... The problem is that a few high profile cases lead naive
people to believe that there are far more malpractice suits than
actually exist and the right wing uses these high profile cases to
spread their misinformation because their handlers have a vested
interest in the issue.

"A report by the consumer advocacy group Public Citizen demonstrated
that the total value of malpractice payments (money paid to resolve
claims) on behalf of providers has been decreasing since 2001 and was
the lowest on record in 2011. While malpractice payments decreased,
healthcare spending nearly doubled over the same period, negating the
claim that malpractice litigation contributes to rising healthcare costs.

Irrelevant. I personally met cardiologists who paid north of $100k in
malpractice premiums. Guess who pays that in the end ...

An examination of the impact of tort reform in Texas supports this
perspective. In 2003, Texas imposed a cap of $250,000 on noneconomic
damages for medical liability claims. Since then, total malpractice
claim payments have declined 65 percent, but health insurance rates and
per-patient Medicare spending has increased faster in Texas than the
national average." Of course the reason that Texas's costs increased
faster after tort reform could be coincidental and due to other factors,
you can't claim causation when it could just be correlation.

Nor is it clear that so-called "defensive medicine" actually adds to
overall health care costs.

It is totally clear to people in the medical field.

Some health economists believe that the fear of malpractice lawsuits is
actually a good thing because it forces hospitals to be more efficient
and to set up systems for things like infection control and drug
verification. One thing you'll notice in U.S. hospitals is that new
hospitals have mostly single rooms because rooms with multiple patients
cause more problems than is worth the savings in cost.

It made our system the most expensive in the world.
 
J

Joerg

Jan 1, 1970
0
sms said:
Technically it's multi-payer, but the concept is pretty much the same.


No. They have one method which has HMOs like we had them until about now
but who cannot deny coverage because of pre-existing conditions. They
also have the "Privatkasse" system which is unfettered by all this and
can deny coverage. I have lived there and had the choice between the two.

It's just that there are mandatory private contributions. It's not like
the U.S. where almost all of the non-Medicare costs of health care are
private. The problem in the U.S., which Romneycare and the ACA addressed
was the subsidizing of those that could afford insurance but decided
that it was better to freeload, ...


.... who, under Obamacare, will continue to freeload. I've met folks who
are planning to do exactly that. What is better: Paying 1% (or in 2-3
years 2.5%) penalty, or >10% of your net income in sky-high premiums?
Many people already have decided their answer and it's not what Dems
thought it would be.

We as a country are in for a rude awakening.
 
S

sms

Jan 1, 1970
0
No, it is not tiny. I leads to over-medication, over-examination, tons
of unnecessary expense. I've been on the beat in med tech for over 25
years now. The topper, when I asked a doc why they bought Acuson
ultrasound machines all the time: "Well, these are by far the most
expensive and I agree with you that we don't need them. But then nobody
in court can accuse us of not having done the best". One of many, many
examples. Leftists stick their heads in the sand about it but that does
not make it go away.

The issue is that even the defensive procedures don't have much of an
effect on overall health care costs. The voices in your head that tell
you that they do can be eliminated by turning off Faux News. This
procedure is unfortunately not part of the ACA.

When hospitals, doctors, health care companies, and lawyers all agree
that the tort system is having a negligible negative effect, if any, on
overall expenses, you'd be better off believing them than listening to
the right-wing talking heads from Faux News, or the Heritage Foundation,
that make stuff up as they go along to suit their own agenda.

Here's where you can begin your education on this issue:

Small Cost Benefit for Tort Reform, More Primary Care
<http://www.kaiserhealthnews.org/stories/2010/september/14/ft-cost-benefit-tort-reform.aspx>

Tort reform has not reduced health care costs in Texas
<http://www.statesman.com/news/news/local/new-study-tort-reform-has-not-reduced-health-care-/nRpcp/>

Tort reform won't provide significant healthcare savings
<http://www.healthcarefinancenews.co...m-wont-provide-significant-healthcare-savings>

$130 Million Verdicts Don’t Raise Medical Costs
<http://www.bloomberg.com/news/2013-08-25/-130-million-verdicts-don-t-raise-medical-costs.html>

It's true that there are expensive tests and defensive medicine and that
drive up costs. Even in Texas they've continued because they were never
really about preventing malpractice suits, they were always about
increasing billable expenses.
 
T

Tim Williams

Jan 1, 1970
0
Joerg said:
No, it is not tiny. I leads to over-medication, over-examination, tons
of unnecessary expense. I've been on the beat in med tech for over 25
years now. The topper, when I asked a doc why they bought Acuson
ultrasound machines all the time: "Well, these are by far the most
expensive and I agree with you that we don't need them. But then nobody
in court can accuse us of not having done the best". One of many, many
examples. Leftists stick their heads in the sand about it but that does
not make it go away.

Would it be fair to say that price is used to judge the efficacy and
reliability of equipment?

Tim
 
S

sms

Jan 1, 1970
0
Would it be fair to say that price is used to judge the efficacy and
reliability of equipment?

No. Because the number of lawsuits where the reliability of such a
machine would be an issue is nil.

Even if you were talking about something like a Gamma Knife versus a
Cyber Knife since each has its pros and cons a plaintiff would have a
hard time suing based on efficacy and reliability.

The bottom line is that the right wing has created this mythical issue
of tort reform as an excuse to avoid doing anything real about health
care. They really do understand that tort reform would have almost no
effect on costs (it actually could drive them up) but their handlers
tell them to use it as a talking point because nothing is better than
bringing up an example of a large award by a jury and then bashing
lawyers. They can wring their hands and proclaim that if only we had
tort reform medical costs would plummet. It's not true.

What tort reform really means is that the average citizen can no longer
use the justice system to determine a fair amount of damages. The amount
of pain that the medical establishment is allowed to suffer at the hands
of legitimate plaintiffs is limited.

<http://www.mlive.com/news/kalamazoo/index.ssf/2012/07/so_why_does_us_health_care_cos.html>
 
J

Joerg

Jan 1, 1970
0
Tim said:
Would it be fair to say that price is used to judge the efficacy and
reliability of equipment?

In front of a jury, yes. If plaintiff's counsel makes a compelling case
around the argument that defendant did not use the best of the best,
having saved $50k on a machine can hit the fan as a million Dollar
settlement.
 
B

Bill Sloman

Jan 1, 1970
0
Those numbers I had given. See links below.

Those links didn't give the number of people who had had polyp removal in terms of patients per 100,000 in the population as a whole. If it were less than 5 per 100,000, your explanation couldn't possible be valid (to set up an extreme hypothetical case)
A better diet? In the US? You've got to be kidding.

"Better" depends on what aspect of the diet one is looking at. All that is required is "different". And you've passed on the differences in age, whichcould be equally significant - cancer is essentially an end of life disease.

http://stevefrank.org/cancer/cancerbook.pdf

talks about it as a multi-stage progression. You need some six successive heritable cell changes to get to a malignant cell, and this shapes the age-dependent incidence.
Sure it does. You said "unsubstantiated" and that is simply wrong.

You haven't provided all the evidence necessary to make your explanation convincing. It is merely plausible, and there are other plausible explanations available for the difference in the colon cancer incidences in the US Canadian and German populations.
Before I'd make such lofty statements I'd have looked up the topic and
would be ready to back up such claims.

In medical, we think in clinical studies and base our strategies on those.. That has worked well for at least a century. You are welcome to ignore that, it won't make a difference.

Medicine has a long history of confusing correlation with causation and other intellectual errors. As for clinical studies, the Korean study that you thought validated the use of your expensive cardiac catheter with the built-in ultrasound imager (a brilliant, if expensive, device) only used it on patients who were healthy enough to tolerate the procedure but you still gotexcited about their better survival rates.
It is standard practice here and the clinical studies clearly bear out
the benefits.

But how many people - per 100,000 in the population - get their polyps snipped?
There is a simple reason: Many Americans dread the thought of a
colonoscopy and push that out. "I can always do that next year ... or
the year after that". Some never get one. Our health care plan folks are
very pushy on this. others are not so pushy. If you are even a few weeks
overdue on some screening procedure you get a call. But in a free
country you cannot force people to report for their colonoscopy on
Thursday morning at 8:00am sharp.

Which is why we need to know what proportion report in for their colonoscopy, and what proportion have polyps that get snipped.

Sorry to be obnoxious about this, but clinical trial don't always mean whattheir sponsors like to claim that they mean. Big pharma has sinned repeatedly in this area, and medicos with irrational convictions can be worse.
 
J

Joerg

Jan 1, 1970
0
Bill said:
[...]

Sure it does. You said "unsubstantiated" and that is simply wrong.

You haven't provided all the evidence necessary to make your
explanation convincing. It is merely plausible, and there are other
plausible explanations available for the difference in the colon
cancer incidences in the US Canadian and German populations.

Frankly, I don't care whether you believe it or not. Medical doctors
know better, even European ones.

https://www.lef.org/news/LefDailyNews.htm?NewsID=14112&Section=Disease

Fact is, polyps are routinely snipped over here because we perform
preventative colon cancer screening. In countries that don't screen via
colonoscopy it is, obviously, impossible to even detect which people
have intestinal polyps and how many. Therefore, obviously, there cannot
be large scale statistics about it in those countries.

[...]
 
B

Bill Sloman

Jan 1, 1970
0
Bill said:
Bill Sloman wrote:
[...]
You don't believe me and call it "unsubstantiated".

I don't disbelieve you either, but there are other explanations. Youcertainly haven't substantiated your polyp-snipping explanation - which would require evidence that enough polyps had been removed to explain the difference, and even that wouldn't demonstrate that there were other factors in play.
Which is flat wrong. You tend to make up this stuff, stuff that clearly contradicts clinical evidence.

Nothing I've said contradicts clinical evidence. ...

Sure it does. You said "unsubstantiated" and that is simply wrong.

It isn't. You are over-interpreting the clinical evidence.
Frankly, I don't care whether you believe it or not. Medical doctors knowbetter, even European ones.

https://www.lef.org/news/LefDailyNews.htm?NewsID=14112&Section=Disease

Fact is, polyps are routinely snipped over here because we perform preventative colon cancer screening. In countries that don't screen via colonoscopy it is, obviously, impossible to even detect which people have intestinalpolyps and how many. Therefore, obviously, there cannot be large scale statistics about it in those countries.

Your claim is in two parts - first that enough polyps are clipped in the USto explain the lower rate of colon cancer there than in Germany and Canada, adn - second - that this is the only explanation of the difference in rate.

Since you can't tell me what proportion of the US population has their polyps snipped, you haven't got to first base on substantiating the first claim..

I'm happy to believe that polyp-snipping works - I've always believed this since I first heard the story. I'm a lot less confident about your claim that there's enough of it done in the US to explain the difference in the rate of colon cancer. As you say, it's not a popular procedure.
 
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